Background

Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice.

Methods

Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach.

Findings

We observed staff engaging in ‘multifactorial talk’ to address patients’ modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with ‘categorisation talk’, which focused on patients’ levels of fall risk and allocating nursing supervision to ‘high risk’ patients. Staff negotiated tensions between these different approaches through frequent ‘hybrid talk’, where, as well as categorising risks, they also discussed how to modify them.

Conclusion

To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients’ individual risk factors and actions to address them (a ‘why?’ rather than a ‘who’ approach); (2) where not possible to avoid ‘high risk’ categorisations, employing ‘hybrid’ communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines to participate.

Background

Measures to evaluate high-risk medication safety during transfers of care should span different safety dimensions across all components of these transfers and reflect outcomes and opportunities for proactive safety management.

Objectives

To scope measures currently used to evaluate safety interventions targeting insulin, anticoagulants and other high-risk medications during transfers of care and evaluate their comprehensiveness as a portfolio.

Methods

Embase, Medline, Cochrane and CINAHL databases were searched using scoping methodology for studies evaluating the safety of insulin, anticoagulants and other high-risk medications during transfer of care. Measures identified were extracted into a spreadsheet, collated and mapped against three frameworks: (1) ‘Key Components of an Ideal Transfer of Care’, (2) work systems, processes and outcomes and (3) whether measures captured past harms, events in real time or areas of concern. The potential for digital health systems to support proactive measures was explored.

Results

Thirty-five studies were reviewed with 162 measures in use. Once collated, 29 discrete categories of measures were identified. Most were outcome measures such as adverse events. Process measures included communication and issue identification and resolution. Clinic enrolment was the only work system measure. Twenty-four measures captured past harm (eg, adverse events) and six indicated future risk (eg, patient feedback for organisations). Two real-time measures alerted healthcare professionals to risks using digital systems. No measures were of advance care planning or enlisting support.

Conclusion

The measures identified are insufficient for a comprehensive portfolio to assess safety of key medications during transfer of care. Further measures are required to reflect all components of transfers of care and capture the work system factors contributing to outcomes in order to support proactive intervention to reduce unwanted variation and prevent adverse outcomes. Advances in digital technology and its employment within integrated care provide opportunities for the development of such measures.

Background and objectives

Clinical debriefing (CD) following a clinical event has been found to confer benefits for staff and has potential to improve patient outcomes. Use of a structured tool to facilitate CD may provide a more standardised approach and help overcome barriers to CD; however, we presently know little about the tools available. This systematic review aimed to identify tools for CD in order to explore their attributes and evidence for use.

Methods

A systematic review was conducted in line with PRISMA standards. Five databases were searched. Data were extracted using an electronic form and analysed using critical qualitative synthesis. This was guided by two frameworks: the ‘5 Es’ (defining attributes of CD: educated/experienced facilitator, environment, education, evaluation and emotions) and the modified Kirkpatrick’s levels. Tool utility was determined by a scoring system based on these frameworks.

Results

Twenty-one studies were included in the systematic review. All the tools were designed for use in an acute care setting. Criteria for debriefing were related to major or adverse clinical events or on staff request. Most tools contained guidance on facilitator role, physical environment and made suggestions relating to psychological safety. All tools addressed points for education and evaluation, although few described a process for implementing change. Staff emotions were variably addressed. Many tools reported evidence for use; however, this was generally low-level, with only one tool demonstrating improved patient outcomes.

Conclusion

Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients.

There are growing calls for healthcare to confront it’s role in the climate crisis. Estimates suggest that carbon emissions from healthcare constitute 5% of net global emissions. To put this into context, emissions from all air travel are estimated at 3.5% of net global emissions.1 Health systems, organisations and clinicians have been called on to lead efforts to reduce emissions given that the climate crisis presents a major threat to human health.

Ensuring appropriateness of care, and reducing overuse are central planks of strategies suggested in the literature and are increasingly being enacted by large healthcare systems and provider organisations to reduce healthcare’s climate impact.2 However, individual clinicians are often left with little guidance or support in terms of how to do this in practice. To illustrate, the Agency for Health Care Research and Quality (AHRQ) within the United States Department of Health and Human...

I write this commentary as wildfires rage around the world, including in Greece, Italy, Siberia, Algeria and the USA. In my own country, Canada, fires have already consumed over 130 000 km21—the size of Greece—and the wildfire season has not yet ended. Recent months have also seen hundreds of millions of people suffering scorching heatwaves across Europe, China and North America. Residents of Phoenix, Arizona, endured temperatures over 43°C for 31 consecutive days this summer. In Italy, harsh heat in the south occurred at the same time as storms delivered hail the size of tennis balls in the country’s north. This almost ‘end of days’ juxtaposition of extreme weather events within a single country comes as new research indicates that the Gulf Stream may collapse as soon as 2025.1 Loss of these vital ocean currents would constitute a climate tipping point, making extreme storms more frequent...

If the detector support component fails, imaging cannot be completed, and the detector may contact the patient.

Smiths Medical recalls Medfusion model 4000 syringe pump due to software issues, impacting the alarm system, pump, control screen, and other components.

The High Frequency Transport Phasitron Breathing Circuit Kit is used for continuous ventilation of patients. The kits are recalled due to a product defect that causes over-pressurization.

“Today The World” is voluntarily recalling two lots of Sustain herbal dietary supplement capsules and one lot of Schwinnng capsules to the consumer level. FDA analysis has found the products to contain undeclared Tadalafil and Nortadalafil (structurally similar to Tadalafil). Tadalafil and Nortadala

“Today The World” is voluntarily recalling one lot of Arize Herbal Dietary Supplement capsules to the consumer level.
FDA analysis has found the products to contain undeclared Nortadalafil (structurally similar to Tadalafil). Nortadalafil is an active drug ingredient known for treatment of male ere

In direct response to the Nurse Assist, LLC voluntary product recall (which included products supplied to Cardinal Health used in Covidien and Cardinal Health™ brand kits and trays), Cardinal Health issued a medical device recall on December 5, 2023, for its Covidien and Cardinal Health™ brand urolo

Insight Pharmaceuticals, a Prestige Consumer Healthcare Inc. company (“Insight”), is voluntarily recalling two lots of TING® 1% Tolnaftate Athlete’s Foot Spray Antifungal Spray Liquid to the consumer level. A recent review by our manufacturer and their third-party lab found that samples from two lot

Cardinal Health Monoject syringes have demonstrated recognition and compatibility issues with certain infusion pumps.

The FDA is warning not to use recalled Cardinal Health Monoject syringes, including Luer-Lock and enteral.

Find answers to frequently asked questions on Philips Respironics ventilators, BiPAP, and CPAP machines recall

This update provides additional information on the recall and recommendations for people who use repaired and replaced devices.

Maquet Express Chest Drain recalled over sterility concerns. When used without the provided syringe, the Express chest drains are safe to use.

Globus Medical, Inc. is recalling the ExcelsiusGPS, an imaging device, due to a calibration algorithm error that may affect the accuracy of implant placement.

Neptune Resources, LLC is voluntarily recalling All lots of Neptune's Fix Elixir, Neptune's Fix Extra Strength Elixir, and Neptune's Fix Tablets to the consumer level. Neptune Resources LLC's distribution channels have not reported any adverse events from the use of its products. The products are be

Woburn, Massachusetts, Azurity Pharmaceuticals, Inc. is voluntarily recalling one (1) lot (F230169A) of Zenzedi® CII (dextroamphetamine sulfate tablets, USP) 30 mg to the consumer level. The product is being recalled due to a report from a pharmacist in Nebraska who opened a bottle of Zenzedi® 30 m